Medication management after intramedullary nailing of atypical fractures.

Long term use of bisphosphonates (BPs) in osteoporotic patients may be associated with stress fractures of the sub-trochanteric and shaft area of the femur, so called "atypical" femoral fractures (AFF). Specific diagnosis criteria have been defined with 5 major features; the presence of four of them characterizes the AFF. Once a complete fracture occurred, the best surgical treatment is closed reduction and intra medullary nailing. The BPs treatment should be stopped immediately after an AFF occurred. Dietary calcium and vitamin D status should be assessed, and adequate supplementation prescribed. Principle of combination of a systematic bone anabolic treatment is strongly debated. The recombinant parathyroid hormone 1-34 or Teriparatide ® (TPTD) has an anabolic effect on bone and prevent osteoporotic fractures. Available preclinical and clinical data have also demonstrated the role played by TPTD to enhance bone fracture healing and the potential beneficial effect in impaired fracture healing or specific clinical condition like AFFs. Some authors have proposed in incomplete BP use stress fractures different medical management according the MRI findings. Bone anabolic agents may be promising both to prevent healing complications in AFFs and to promote healing in conservative treatment of incomplete AFFs. More clinical studies are needed to confirm this hypothesis.

Stress fracture of the radial styloid process in a judo player: a case report.

Stress fractures of the upper limbs are uncommon, and are most often reported as individual cases or small series. In particularly, stress fractures around the wrist are even less common. A stress fracture of the radial styloid process in a judo player was surgically treated, and a favorable treatment outcome was obtained. A 16-year-old adolescent boy experienced pain in the right wrist, with no apparent trigger, while playing judo. Stress fracture of the radial styloid process was diagnosed with plain radiographs and was treated conservatively with cast immobilization. Although bone union was achieved, the fracture recurred after he resumed paying judo. Thus, surgical treatment was performed. The procedure was resection of the distal bone fragment. He resumed practicing 2 months postoperatively and returned to judo matches after 1 more month. As of 1 year after distal bone fragment resection, he was able to participate in judo without pain, limited range of motion, or instability of the wrist.

Arthroscopic removal of dorsoproximal chip fractures of the proximal phalanx in standing horses.

OBJECTIVE: To report a technique for, and outcome after, arthroscopic removal of dorsoproximal chip fractures of a proximal phalanx in standing horses. STUDY DESIGN: Retrospective study. ANIMALS OR SAMPLE POPULATION: A total of 104 horses, 1 to 13 years of age, with a dorsoproximal chip fracture of a proximal phalanx. METHODS: Horses were restrained in standing stocks and sedated with intravenous xylazine, detomidine, or a combination of both drugs. Local analgesia was achieved with 2% mepivacaine administered intra-articularly and by subcutaneous infiltration in a crescent-shaped block dorsal to the fetlock. Sterile drapes were placed on the surgical field, and impervious drapes were used on the hoof and floor. Arthroscopic portals were created in the dorsal pouch of the metacarpophalangeal or metatarsophalangeal joints to remove chip fractures. Statistical analysis was performed on race records for all Thoroughbred racehorses and compared with previously published studies. Operative and hospitalization times were compared with those of the general hospital population, and risks associated with general anesthesia were examined. RESULTS: No major operative or postoperative complications occurred. Ninety-one percent of racehorses raced after surgery with 78% returning to race at the same or higher level. CONCLUSION: Standing arthroscopic surgery can be performed successfully to remove dorsoproximal chip fractures of the proximal phalanx. CLINICAL RELEVANCE: Standing arthroscopic surgery is a valid alternative treatment for experienced surgeons to avoid the expense and potential risks associated with general anesthesia.

Classification and diagnosis of intracapsular fractures of the proximal femur.

Intracapsular fractures of the hip have been classified by different authors with a basis on various concepts. Pauwels classified these fractures according to the angle of inclination; Linton used trabecular disposition among the fractural fragments, and Garden described four types according to the order of displacement. The AO group used the comprehensive classification of fractures of the long bones and divided them among types, groups, and subgroups. However, the presence of posterior comminution of the femoral neck in intracapsular fractures as a factor foretelling instability was overlooked by each of the aforementioned classifications. With a basis on the factors previously described, the current authors developed a classification in which the criteria of instability in intracapsular fractures are given priority. Consequently, the characteristics of full or partial lines, angulation, displacement, and the presence of posterior comminution have been considered. Radiology is the first complementary study for diagnosis; it enables observation of the fracture line or trabecular changes in most cases and fragmental displacement and posterior comminution of the neck. In patients with stress fractures, radiographs often fail to show alterations, so a different diagnostic methodology is required. A diagnosis algorithm is presented. Differential diagnoses are focused toward diseases that may reveal images of pseudofractures.